1114113545 NPI number — FREDERICK A BARKS, JR

Table of content: (NPI 1114113545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114113545 NPI number — FREDERICK A BARKS, JR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREDERICK A BARKS, JR
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PUTNAM CHIROPRACTIC CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114113545
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
245 SCHOOL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUTNAM
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06260-1621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-928-7729
Provider Business Mailing Address Fax Number:
860-928-0593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 SCHOOL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUTNAM
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06260-1621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-928-7729
Provider Business Practice Location Address Fax Number:
860-928-0593
Provider Enumeration Date:
09/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARKS
Authorized Official First Name:
FREDERICK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
860-928-7729

Provider Taxonomy Codes

  • Taxonomy code: 111NN1001X , with the licence number:  001391 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3823400 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: C03295 . This is a "MEDICARE GROUP ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 050001391CT02 . This is a "BCBS OF CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V5130 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 412398 . This is a "BLUE CHIP OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 010391 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: AA32943 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P00217640 . This is a "MEDICARE ID - RAILROAD ME" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1030756 . This is a "ASHN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P2686322 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 29336-1 . This is a "BCBS OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 4404611 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06985925002 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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